Indian Space Research Organisation
Telemedicine:lndian Space Agency's (ISRO) Initiatives for Speciality Health Care Delivery to Remote & Rural Population
L.S.Satyamurthy, A. Bhaskaranarayana


Introduction
In today's world with several advancements made in the medical field still the benefits are available to the privileged fielv, residing mainly in the urban areas. With the advent of communication technology especially the SatCom combined with Information Technology, we have means to benefit from the advanced medical sciences to reach even the remote and inaccessible areas. It is known that in developing countries most of the qualified doctors practice in urban centres where as majority of population live in rural areas. Indian Space Research Organisation (ISRO) as a part of application of space technology for Health care and education, under GRAMSAT (rural satellite) programme, has initiated number of Telemedicine pilot projects which are very specificto the needs of development of the society.ISRO's Telemedicine projects consist of linking through Indian Satellites remote/rural areas like Jammu, Kashmir & Ladhak in north near Himalayas, Offshore Islands of Andaman and Lakshadweep, North Eastern States & some of the remote and tribal districts in the main land States across the country.

While ISRO has an impressive record of achievements in space technology covering satellites, launch vehicle services and applications, Telemedicine is one of ISRO's continuous endeavours in bringing application of space technology for the benefit of the grass root population. In this regard the Telemedicine pilot projects initiated by ISRO are very specific to the needs of development. While health care is not our primary subject, application of space technology for health care and education is the focus. Since health care is the State subject and run by the State Governments, the thrust of ISRO is to introduce SatCom based Telemedicine technology in the remotest part of the country through pilot projects so that the health care system will have sufficient training & experience to run the facility & subsequently introduce Telemedicine in operational mode.

ISRO's Telemedicine initiative has been broadly divided into the following areas:

  1. Providing Telemedicine Technology & Connectivity between remote/rural hospital and Super Speciality Hospital for Teleconsultation & Treatment and Training of doctors & paramedics.
  2. Providing the Technology & Connectivity for Continuing Medical Education (CME) between Medical Colleges & Post Graduate Medical Institutions/Hospitals.
  3. Providing Technology & Connectivity for Mobile Telemedicine units for rural health camps especially in the areas of ophthalmology and community health.
  4. Providing Technology and Connectivity for Disaster Management Support and Relief.
ISRO's Initiatives
ISRO's Telemedicine pilot project was started in the year 2001 with the aim of introducing the Telemedicine facility to the grass root level population as a part of 'proof of concept technology demonstration' programme. The Telemedicine facility connects the District Hospitals/Health Centres with Super Speciality Hospitals for providing expert consultation to the needy and underserved population.


Telemedicine system consists of customized medical software integrated with computer hardware, along with medical diagnostic instruments connected to the commercial VSAT (Very Small Aperture Terminal) at each location. Generally, the medical record/history of the patient is sent to the Specialist Doctors, who will in-turn study and provide diagnosis and treatment during video-conference with the patient's end.

ISRO's Telemedicine Network
Presently ISRO's Telemedicine Network consists of 100 Hospitals - 78 Remote/Rural/District Hospitals/Health Centres connectedto 22 Super SpecialityHospitals located in the major cities with the following highlights:
  • 9 Hospitals in the State of Jammu & Kashmir including 3 Medical College Hospitals connected to All India Institute of Medical Sciences, Delhi; Apollo Hospitals,Delhi & Amritha Institute of Medical Sciences, Kochi.
  • 5 islandsof Lakshadweepconnected to Amritha Institute of Medical Sciences , Kochi.
  • 10 Remote/field/Base Hospitals for Indian Army connected to Research & Referral (R & R) Hospital at New Delhi.
  • 10 hospitals of North Eastern States - connected to Asia Heart Foundation , Kolkata / Amrita Institute, Kochi / AIIMS,New Delhi / Apollo, New Delhi.
  • Tata Memorial Cancer Centre Mumbai , connected to B B Barua Cancer Centre , Guwahati and WalWaker Cancer Unit at Chiplun, Maharashtra.
  • Temporary Telemedicine facility for 2 months every year at Pampa at the foothills of Sabarimala shrine in Kerala.
  • Mobile Telemedicine - Mobile Teleopthalmology facility provided to ShankaraNetralaya, ChennaiandAravind Eye Hospital, Madurai, Tamilnadu.
  • Three Medical College Hospitals of Orissa connected to Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow.
  • 3 District Hospitals of Karaikal (familnadu), Mahe (Kerala) and Yanam (Andhra Pradesh) of the UT of Pondicherry connected to General Hospital & ]IPMER, Pondicherry.
  • 3 District Hospitals of WestBengal, connected to SSKM and Ramakrishna Prathisthan Hospital, Kolkata.

Telemedicine during Tsunami
ISRO's Telemedicine facilities at three Hospitals - GB Pant Hospital & INHS Dhanvantari at Port Blair, Andaman Island and Bishop Richardson Hospital at Car Nicobar along with ISRO GRAMSAT Network at 8 islands are effectively used during post Tsunami disaster relief work for the benefit of the remote population of Andaman and Nicobar Islands. More such Telemedicine centres are being planned at the primary health centres of various islands of Andaman and Nicobar.

Mobile Telemedicine
Mobile Telemedicine Unit consisting of Medical equipment along with Telemedicine hardware, software and VSAT system mounted in a Bus/Van can establish a Mobile Telemedicine centre at any place.

The major areas of Mobile Telemedicine applications are in the field of Tele Opthalmology and Community Health. Under Mobile Tele Opthalmology, Rural Eye Camps can be conducted and the Rural Population can undergo eye screening for Cataract, Glaucoma and Diabetic Retinopathy. Under Community Health Program, Mobile Telemedicine units are very useful not only for Disease Prevention but also for Health Promotion in terms of running awareness camps & teaching hygienic practices.

Village Resource Centres and Telemedicine
Recently, ISRO has also initiated pilot projects for integrating Telemedicine/ Tele-health with the Resource Information database as well as Tele-Education facilities at the Village Resource Centres/Community Centres (VRC) to reach out to more rural areas of the country. The ftrst of the pilot projects has been implemented in the state of Tamil Nadu wherein the nodal centre operated by an NGO agency at Chennai is connected to remote villages in three districts and more are to come in the future.

One of the major advantages of Telemedicine technology has been the saving of cost and effort to the rural patients as they are not required to travel long distances for obtaining consultation and treatment.

Imapct Study
A study conducted by an independent agency on one thousand patients in the Chamarajanagar district hospital in Karnataka has revealed that there was a cost saving of 81% to the patient. That is, the patients who availed the Telemedicine consultation and treatment spent only 19% of the money which they would have otherwise spent if they had to travel to the nearest cities for a similar treatment. In the caseof remote off-shore islands, this is much more signiftcant both to the patient and the Government administration. In such cases, not only the patients have the cost saving but can be provided with quick and timely medical aid.

Future
ISRO's Telemedicine Project is gaining more acceptability and has potential to open up new frontiers for the rural health care in India. Some States have come forward to introduce Telemedicine in an operational mode and have prepared the District Hospitals with Telemedicine facilityboth for Ambulatory & Intensive care for cardiac related treatment. States of Karnataka, Kerala and Chhattisgarh have initiated the establishment of SatCom Based Telemedicine facility in all their district hospitals which will be connected to different Speciality Hospitals in the major cities. This will soon be followed by other states too. With the steady growth of Telemedicine application, it is also envisaged to develop an exclusive "HEALTHSA T" for meeting the health care needs of the country at large.